不同类型自身免疫性肝病的组织学特征及ERα、TGF-β1表达的意义

Histological features and significance of ERα and TGF-β1 expression among different types of autoimmune liver diseases

目的:比较自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)及慢性乙型肝炎(CHB)的组织学特征,并探讨雌激素受体α(ERα)及转化生长因子β1(TGF-β1)在各组肝活检中的表达及意义.方法:应用HE染色对29例I型AIH、18例PBC、15例CHB肝穿标本进行组织学特征分析,应用免疫组织化学方法检测各组ERα及TGF-β1的表达情况,设8例正常肝组织(非肝病患者尸检来源的肝组织)为对照.结果:各组肝活检组织学特征中羽毛状变性、胆栓、胆管增生的发生率的差异具有统计学意义(33.33%vs3.45%,6.67%;44.44%vs6.92%,6.67%;61.11%vs34.48%,13.33%,均P<0.05).TGF-β1在PBC组汇管区的阳性细胞数高于肝小叶(31.80±15.92vs16.00±6.28,P<0.05),各组间汇管区阳性细胞数PBC组高于其他3组(31.80±15.92vs10.00±12.15,13.44±13.51,3.20±3.20,均P<0.01),在正常组肝小叶内阳性细胞数高于汇管区(16.85±3.48vs3.20±3.20,P<0.01).ERα在各组的表达AIH和PBC组高于正常组(94.78±48.36,110.40±36.66vs28.98±24.60,均P<0.01).结论:不同类型的自身免疫性肝病的组织学特征有所不同,AIH以肝小叶界板的损伤为主要改变,而PBC以胆管上皮损伤为主要特征.ERα及TGF-β1可能介导和促进了自身免疫性肝病的发生发展.

AIM：To summarize the histological features of autoimmune hepatitis（AIH）,primary biliary cirrhosis（PBC） and chronic virus hepatitis of type B（CHB）,and to investigate the significance of ERα and TGF-β1 expression in the above liver diseases.METHODS：Histological examination was performed using liver biopsy specimens from 29 patients with AIH,18 patients with PBC,and 15 patients with CHB.Immunohistochemistry was used to detect the expression of ERα and TGF-β1 in the above specimens and 8 normal liver tissue specimens.RESULTS：The incidences of feathery degeneration,bile thrombus,and bile duct hyperplasia were significantly different among AIH,PBC,and CHB（33.33% vs 3.45%,6.67%;44.44% vs 6.92%,6.67%;61.11% vs 34.48%,13.33%;all P 0.05）.In patients with PBC,the expression of TGF-β1 was significantly higher in the portal area than in the hepatic lobule（31.80 ± 15.92 vs 16.00 ± 6.28,P 0.05）.The expression of TGF-β1 in the portal area was significantly higher in PBC than in the other three groups（31.80 ± 15.92 vs 10.00 ± 12.15,13.44 ± 13.51,3.20 ± 3.20,all P 0.01）.In normal controls,the expression of TGF-β1 was significantly higher in the hepatic lobule than in the portal area（16.85 ± 3.48 vs 3.20 ± 3.20,P 0.01）.The expression of ERα was significantly different among the four groups.The expression of ERα was significantly higher in AIH and PBC than in normal controls（94.78 ± 48.36,110.40 ± 36.66 vs 28.98 ± 24.60,both P 0.01）.CONCLUSION：Different autoimmune liver diseases have different histological features.AIH is characterized by interface hepatitis,and PBC by destructive cholangitis.ERα and TGF-β1 may mediate and promote the development and progression of autoimmune liver diseases.